Racial / Ethnic Disparities in Substance and Alcohol Abuse Treatment

Objectives:

To measure racial/ethnic disparities in substance abuse treatment and mental health services among the U.S. non-institutionalized adult population with substance or alcohol abuse or dependence. To understand how criminal history and socioeconomic status mediate the relationship between race/ethnicity and receipt of substance abuse treatment.

Data

Nationally representative sample of non-Latino Whites, Black, and Latino individuals age 18 and over with substance or alcohol abuse or dependence (SAD) from the 2005-2007 National Survey of Drug Use and Health.

Methods

To measure substance abuse treatment disparities, we implement the Institute of Medicine (IOM) definition of healthcare disparities, adjusting for level of substance use and mental health status. We evaluate the role of criminal history and socioeconomic status as mechanisms explaining disparities or lack of them. Using staged models, we describe the mediation effect of criminal history and SES-related variables on the relationship between race/ethnicity and receiving substance abuse treatment for substance use disorders.

Results

Overall, less than one-tenth of individuals with SAD received substance abuse treatment in the last year. Rates of treatment for individuals with SAD were higher for Blacks (10.1%) and Latinos (9.2%) than Whites (8.5%), though these differences were not statistically significant. Sequential models suggest that criminal activity and socioeconomic status are potential mediators of these treatment differences. A larger percentage (27%) of individuals with SAD used either mental health or substance abuse treatment services. The rates on this treatment measure were significantly higher for whites (29%) than for Blacks (21%) and Hispanics (22%).

Conclusion

Blacks and Latinos have equal if not greater access to substance abuse treatment, after controlling for level of substance use and mental health status, and this treatment is strongly correlated with having a criminal history. This suggests that mandated or strongly incentivized treatment programs may provide access to individuals otherwise resistant to care, but also raises ethical concerns. The existence of disparities in any mental health or substance abuse treatment among individuals with substance abuse disorder, combined with the overall low rates of substance abuse treatment, suggests that improvement in the integration of substance abuse and mental health services is warranted.